Hepatitis A
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Hepatitis A (Botkin's disease) is an acute infectious viral liver disease with a benign course, which belongs to the group of intestinal infections. The disease is widespread in developing countries. This is due to the large overcrowding of the population and poor sanitary and hygienic living conditions. In developed countries, the incidence rate of hepatitis A decreases annually due to the hygienic skills of the population, as well as the vaccination.
Icteric stage of hepatitis A
Causes and risk factors
The causative agent of hepatitis A belongs to the RNA-containing viruses of the genus Hepatovirus. It is stable in the external environment, remains active at room temperature for several weeks, dies under the influence of ultraviolet radiation and high temperatures.
The source of infection is a sick person who releases the virus into the environment with feces from the last days of the prodromal period to the 15-20th day of the icteric period. A great role in the spread of infection in patients with anicteric (erased) forms of hepatitis A, as well as virus carriers.
Diagram of the structure of the hepatitis A virus
The main routes of transmission of the virus are food and water. The contact-household transmission route (through personal hygiene items, dishes) is also possible, but it is observed much less often. The risk of infection is mainly associated with poor sanitation and hygiene practices and the use of untreated water.
Adults and children of all ages, including infants, are susceptible to hepatitis A.
Forms of the disease
Depending on the clinical picture, two forms of hepatitis A are distinguished:
- typical (icteric);
- atypical (anicteric, erased).
Symptoms of the icteric form of hepatitis A
Disease stages
In the clinical picture of viral hepatitis A, there are several successive stages:
- Incubation period. It lasts from the moment of infection until the first signs of the disease appear, from 20 to 40 days (on average, 14–28).
- Prodromal period. Symptoms of general malaise appear (weakness, fever, dyspepsia). Duration - 7-10 days.
- Icteric period. Dyspepsia intensifies, icteric staining of the sclera and skin appears. With an atypical course of the disease, the yellowness of the skin is minimally expressed and is often not noticed either by the patient himself or by the people around him. Duration - 5-30 days (average - 15).
- Convalescence period. The symptoms of the disease gradually disappear, the condition of the patients improves. The duration is individual - from several weeks to several months.
Symptoms
Viral hepatitis A usually has an acute onset. The prodromal period can occur in different clinical variants: dyspeptic, febrile, or asthenovegetative.
The febrile (flu-like) form of the prodromal period is characterized by:
- increased body temperature;
- general weakness;
- headache and muscle pain;
- sore throat, dry cough;
- rhinitis.
With the dyspeptic variant of the pre-icterus period, the manifestations of intoxication are weak. Usually, patients complain of various digestive disorders (belching, bitterness in the mouth, bloating), pain in the epigastrium or right hypochondrium, defecation disorders (constipation, diarrhea, or their alternation).
In most patients with hepatitis A, the temperature rises to 38-39 degrees
The asthenovegetative form of the prodromal period in viral hepatitis A is not specific. It manifests itself as weakness, lethargy, adynamism and sleep disorders.
The transition of the disease to the icteric stage is characterized by an improvement in the general condition, normalization of body temperature against the background of the gradual development of jaundice. However, the severity of dyspeptic manifestations in the icteric period not only does not weaken, but, on the contrary, increases.
In severe cases of viral hepatitis A, patients may develop hemorrhagic syndrome (spontaneous nosebleeds, hemorrhages on the skin and mucous membranes, petechial rash).
On palpation, a moderately painful liver protruding from the hypochondrium is revealed. In about 30% of cases, the spleen is enlarged.
As the jaundice increases, the feces become lighter and the urine darkens. After a while, the urine acquires a deep dark color, and the feces become light gray (acholic stools).
The icteric period is replaced by the stage of convalescence. There is a gradual normalization of laboratory parameters and an improvement in the general condition of patients. The recovery period can last up to six months.
Diagnostics
Diagnosis of hepatitis A is carried out according to the characteristic clinical symptoms of the disease, data from a physical examination of the patient and laboratory tests. A biochemical blood test reveals:
- bilirubinemia (an increase in the concentration of bilirubin, mainly due to the bound form);
- a significant increase in the activity of liver enzymes (AST, ALT);
- decrease in prothrombin index;
- decreased albumin content;
- a decrease in thymol and an increase in sublimate samples.
Changes in the general blood test are also noted: increased ESR, lymphocytosis, leukopenia.
If hepatitis A is suspected, a blood test is performed
Specific diagnostics is carried out based on the detection of antibodies using RIA and ELISA. The most accurate method of serodiagnostics is the detection of viral RNA in the blood using polymerase chain reaction (PCR).
Virological research with the isolation of the virus itself is not carried out in clinical practice due to the high complexity of this method.
Treatment
In most cases, hepatitis A is treated on an outpatient basis; hospitalization is indicated only for epidemiological indications or in case of a severe course of the disease.
During the height of clinical signs, bed rest is recommended. The main role is assigned to diet therapy (diet No. 5 according to Pevzner):
- eating 5-6 times a day in small portions;
- exclusion from the diet of fatty and spicy foods, as well as products that stimulate the synthesis of bile;
- the inclusion in the diet of a sufficient amount of vegetable and dairy products.
The use of alcoholic beverages is strictly prohibited.
In case of intoxication, patients are shown to drink plenty of fluids (mineral water and rosehip decoction
Etiotropic therapy of the disease has not been developed, therefore, therapeutic measures are aimed at eliminating symptoms. In case of severe intoxication, patients are prescribed a plentiful drink (rosehip decoction, mineral water without gas), intravenous drip of crystalloid solutions, vitamin therapy. To improve the functions of the digestive system, the use of lactulose is indicated. In order to prevent cholestasis, antispasmodic drugs are used.
Possible complications and consequences
Viral hepatitis A usually proceeds in a mild or moderate form; they are not characterized by any complications. In rare cases, the virus can provoke an inflammatory process in the biliary system, which can result in:
- cholecystitis;
- cholangitis;
- biliary dyskinesia.
Acute hepatic encephalopathy in hepatitis A is extremely rare.
Forecast
The prognosis for viral hepatitis A is favorable. The disease in most cases ends with a complete recovery within 3-6 months. Carriage of viruses and chronicity of the pathological process in the liver are not typical for this type of hepatitis.
Prevention
General preventive measures aimed at preventing the spread of hepatitis A virus include:
- provision of the population with quality drinking water;
- careful control over wastewater discharge;
- control over the observance of sanitary and hygienic requirements by employees of public catering establishments, catering units of medical and children's institutions.
In case of an outbreak of hepatitis, quarantine measures are carried out in an organized team. The sick are isolated for 15 days, since from the 14-15th day from the onset of the icteric period, the release of the virus by them stops. The contacts are under medical supervision for 35 days. Disinfection is carried out in the focus of infection. The admission to study or work of persons who have had hepatitis A is carried out only after the onset of complete clinical recovery.
Vaccination is one of the methods of preventing hepatitis A
It is possible to carry out specific prophylaxis of hepatitis A by vaccination. The introduction of the vaccine is recommended for children over one year of age and adults living in regions with high incidence of hepatitis A, as well as those traveling to these regions.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
